Individual
MS. LYNN A WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
401 ADAMS AVE, LA GRANDE, OR 97850-1619
(541) 786-8604
(541) 962-7479
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-8526
(541) 962-7479
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
200550083NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
831399009
REGENCE
OR
Enumeration date
08/08/2006
Last updated
01/25/2016
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